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Long-term Care

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Physician recommendations and patient concerns about vaccine safety are associated with elderly influenza vaccination rates

Influenza causes about 20,000 deaths each year, with elderly and chronically ill people at greatest risk. It is estimated that the influenza vaccine can prevent thousands of deaths each year; yet in 1999, only 67 percent of elderly people received the vaccine. To improve rates of influenza vaccination among the elderly, doctors need to specifically recommend the vaccine to elderly patients, and educational campaigns should focus on myths about adverse reactions to the vaccine, according to Richard Kent Zimmerman, M.D., M.P.H., of the University of Pittsburgh.

In a recent study supported by the Agency for Healthcare Research and Quality (HS09874), Dr. Zimmerman and his colleagues conducted a telephone survey of elderly patients who had visited an inner city health center, Veterans Affairs (VA) clinic, or rural or suburban practice after September 30, 1998, about their ease of getting to a place to be vaccinated, beliefs about and motivation for vaccination, and receipt of vaccination.

Overall, 1,007 men and women completed interviews. Influenza vaccination rates were 91 percent (over the 90 percent Healthy People 2010 goal) for VA clinics, 79 percent at both rural and suburban practices, and 67 percent at inner city health centers. Nearly all elderly people who were vaccinated said that their doctors recommended influenza vaccinations, compared with 63 percent of those who were not vaccinated.

Nearly all of those surveyed were aware of recommendations that they get yearly influenza vaccinations and found it easy to get to a place to be vaccinated. The most common concerns cited by those who were not vaccinated were fear of contracting influenza from the vaccine and adverse effects. For instance, 38 percent of people who were not vaccinated were concerned that they would get influenza from the vaccine, compared with only 6 percent of those who were vaccinated. The researchers recommend that doctors use patient reminders, standing orders to vaccinate, and other methods used by the VA clinics in this study to boost elderly vaccination rates.

More details are in "What affects influenza vaccination rates among older patients? An analysis from inner-city, suburban, rural, and Veterans Affairs practices," by Dr. Zimmerman, Tammy A. Santibanez, Ph.D., Janine E. Janosky, Ph.D., and others in the January 2003 American Journal of Medicine 114, pp. 31-38.

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